As you know from my acceptance post, I’ve largely come to terms with my fears about cancer. That’s allowed me to start reading a number of other blogs from people who have cancer. There are some striking differences when one compares prostate cancer to most other cancers, especially stage IV cancer.

As I understand it, most cancers love to eat sugar. Prostate cancer loves to eat testosterone. Drugs like lupron and casodex either stop the production of testosterone or make it “indigestible” to prostate cancer. As soon as you’re diagnosed with stage IV prostate cancer, you’re almost guaranteed to go on one of these drugs.

When prostate cancer metastasizes and becomes stage IV, it often picks bones to infect with the spine being a common choice. The current standard of care, according to my oncologist, is to leave the cancer untreated until bone pain starts. At that time, radiation is used. (I decided to aggressively treat the spots that appeared on my spine and had radiation before bone pain started.) Surgery isn’t a viable option. That’s why you rarely hear of someone recently diagnosed with stage IV prostate cancer is headed to surgery.

Hormonal drugs do a very good job, at least initially, of removing prostate cancer’s food source. The cancer’s growth is greatly slowed. Eventually, prostate cancer cells develop the ability to make their own testosterone. On average this takes about two years. If the prostate cancer is detected before it’s symptomatic, taking lupron or casodex may provide a significant asymptomatic period of time. One must still live with the side effects from hormonal drugs, obviously. (This is precisely where I am right now. I’ve been on casodex or lupron for about 9 months.) When these hormonal drugs fail, there’s now another drug to use, zytiga. It suppresses testosterone from the testes, the adrenal gland, and the prostate cancer! It appears to significantly extend survival, perhaps by as much as 18 months. It’s awaiting FDA approval as I write this. It’s horribly expensive. After zytiga fails, chemotherapy is the final choice. The point of all of this is that, unlike other stage IV cancers, chemotherapy may not start until years after the diagnosis. This is the good news part of stage IV prostate cancer. If caught early, you have a fair amount of time to get your affairs in order. It also leads to some awkward situations. When folks, who know I’ve had stage IV cancer for 10 months and haven’t seen me since the diagnosis, finally do see me for the first time, they’re shocked. I have all my hair, I’m still at a good weight, and I look perfectly healthy. Most assume there was either a big mistake in the diagnosis or I’m in some sort of miracle remission.

Finally, there’s the difference that has to do with chemotherapy. In most cancers there’s a hope that chemotherapy will produce remission. That’s not the case with prostate cancer. Remissions are very rare. My oncologist tells me that chemo can extend life on average about 1 year more or less and then it’s over. With many other cancers, enduring chemo is made easier by the hope of getting the gold ring of remission. With prostate cancer your life is extended, but you’re under chemo’s thumb for all of that extended life. That’s why prostate cancer patients may decide to forgo chemo. (I’ll probably try it, but expect to opt out.) Hopefully, medical advances will provide drugs that can either produce remission or at least reduce side effects.

Thanks! Doubt it will apply to me, unless I got involved in a clinical trial. They haven’t started human trials yet, so it will be many years to FDA approval (if it gets there). I’ll keep it in my back pocket as a possible trial candidate though.